HomeMy WebLinkAbout1993-03-31 Application for Permit, SewerCITY OF OROVOBox 66 (1335 So Brown Rd)
Crystal Bay, HN 55323
APFLICRTIOR FOR UTILin PERMITS SRIin NRTRR
n^^^^ylSr utility pezndts by nail or In peracm at the aty offices.
2. Mailed in applications are subject to the postage and handling fees shown below.
Pendt cards will be sent by return neil the ease day the application is received.
3. Bnite axe not selld wtU yon xeaslve a pendt cexa.
4. fioxfc mat not begin unless the pexxit card is available on the job site.
5. Utility connection permits nay be issued to licensed contractors only.
6. Contact the Public Mbrks Dqmrtment (473-7357) for utility stub as-built locations.
DO MOT BQCa^VJms m fW soar mo do not W any main without express approval of the
Public fioxfcs Department. Issuance of a permit does not grant this approval.
7. All work Bust be dene in acoardanoe with State Code reqidrenents*
8. All leirk mat be inspected before it is covered. Chll 473-7357.
24 hour notion raqiiixnd.
JOB BITS ADDRBSSt
Occupancy Typei
12U iD 1 ( P J
*8 HAMli
Residential ercial
Phone No.:
_ _ City:
Dus. Phone:
Mailing Address:
OOBTRBCTOR*8 MAMBi^^^^^ . ous
Mailing Address: I City:
PBRNZT nPB MD FBB CALCOLATIOI|, ^
mnCIPAli SIMBR CO—CTIOB ($30.00 per s.tub) $_^_____________________
pipe sise y inches: material PVC (on sand fill)icast iron
SAC Charge (^700.00) must accompany all sewer permit applications unless
prepaid. If not prepaid, a sewer connection permit will not be issued.
MOBICZPAL MATKS COCTBCTIOB ($30.00 per stub) $_ _ _
pipe sise inches: material _ copper: other _ _ ______
MATER METBSTmust be picked up anapaid for at City Hall.
(5/8* meters - $133.00} 3/4* meters - $181.00} 1* meters - $235.00)
Water meters must be set and seeled by Oroiio Water Department (473-73R7>
upon eempletioe of meter installatiom.
REQUIRED minimum setbacks from drainfield and septic tanks ■ 75*
REQUIRED setback from sewer line - 20*
4r-
1. Subtotal of above permit requested
2. State Surdiarge
The State Building Code Division Surcharge
Adi
.50
of .50 per permit must be
included for each well, sewer and water connection permit requested.
1.50_ _ _ _ _3. Foetage a Bandling (Only mail-in applications)
4. TOTAL FEMIT FBB (add lines 1-3 above) $.
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit,
agrees to do all work in strict accordance with the ordinances of the City and the
regulations of the State of Minnesota, and certifies that all statements made on this
applicstion are ccsplete, tzw.and correct.
Signature of Applicant;(/^_^ ^
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